National Audit for Psychological Therapies. A Report For Service Users

Psychological therapy services demonstrate benefits for patients but further improvement is needed, national clinical audit report find:-

A report into the care received by patients with anxiety and depression across more than 350 NHS-funded psychological therapy services in England and Wales has revealed good overall standards of care but substantial variation in quality.

The National Audit of Psychological Therapies – commissioned by the Healthcare Quality Improvement Partnership (HQIP) and carried out by the Royal College of Psychiatrists’

Centre for Quality Improvement – collected data from 357 services and over 10,000 people in therapy for anxiety and depression. The audit measured ten standards, including patient satisfaction, effectiveness of therapy, waiting times and number of treatment sessions offered.

Some 80% of patients said they felt well supported by their therapist and confident in their therapist’s ability. Importantly, 49% of the patients included in the audit had recovered by the end of psychological therapy. These findings indicate that good-quality NHS psychological therapy is helping many people with anxiety and depression achieve better mental health.

However, not all services routinely measure how well patients were before and after therapy, so it is not yet possible to draw firm conclusions about how effective all the services in England and Wales are. The audit report urges all psychological therapy services to routinely collect information about what response people make to the treatment they are given.

The audit found that services are generally good at providing psychological treatments for which there is empirical evidence of their effectiveness and are recommended by the National Institute of Health and Clinical Excellence (NICE). However, not all services record the diagnosis of their patients, making it difficult to know whether or not the care they are providing is appropriate for their patients.

Many services, particularly larger ones, are effective at ensuring that patients are seen quickly once referred. However, this standard was not met by all services, with one in seven people in the audit waiting more than three months for their first appointment. Waiting times are important as patient feedback indicates that long waits can have a negative impact on a person’s mental health.

The report also identified that 56% of patients either received the recommended minimum number of sessions or recovered. However, of those who did not receive the recommended number of sessions, 41% neither recovered nor made reliable improvement.

The audit findings suggest that older people are less likely to access psychological therapy compared to working age adults and this is a finding that needs exploring further. In terms of ethnicity, no particular groups appear to be over or underrepresented at the national level.

Overall, the findings reveal that psychological therapy services are meeting a high number of standards, but support is needed to help some services improve. Services that currently fall below the audit standards are being supported to make positive changes through action planning resources.  A re-audit will then take place to see what improvements have occurred.

Professor Mike Crawford, Director of the Centre for Quality Improvement and NAPT Audit Lead commented:

“The NHS provides more psychological therapies now than it ever has done. This first national audit of NHS-funded psychological therapy services confirms the benefit of much of the treatment provided. We know that people with anxiety and depression highly value being able to access good quality psychological therapy in a reasonable timescale, and this is exactly what many patients are experiencing. However, the variation between services means that there remains plenty of room for improvement. These findings will help individual NHS services see where they can improve and provide even better treatment in the future.”


Mental health problems are common in the UK. According to the 2007 Office for National Statistics Adult Psychiatric Morbidity Survey of England:

  • The proportion of the adult population in England with at least one common mental health disorder is 17.6% in 16-64 year olds and 10.2% in older adults.
  • The most prevalent common mental health disorders are generalised anxiety disorder (4.3% of the population), depressive episode (2.3%) and mixed anxiety and depressive disorder (9%).



The Royal College of Psychiatrists’ Centre for Quality Improvement:

The College Centre for Quality Improvement manages an extensive programme of national clinical audits, clinical services accreditation and national quality improvement networks that involve nearly all mental health services in England and Wales.


The Healthcare Quality Improvement Partnership (HQIP) is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. Its aim is to promote quality improvement, and in particular to increase the impact of clinical audit in England and Wales. HQIP hosts the contract to manage and develop the National Clinical Audit and Patient Outcomes Programme (NCAPOP). The programme comprises 40 clinical audits that cover care provided to people with a wide range of medical, surgical and mental health conditions.

ABOUT Governance of the audit:

The audit is managed by the Royal College of Psychiatrists’ Centre for Quality Improvement, working in close partnership with professional and service user representatives including the following bodies:

  • Anxiety UK
  • The British Association for Behavioural and Cognitive Psychotherapies
  • The British Association for Counselling and Psychotherapy
  • The British Psychoanalytic Council
  • British Psychological Society
  • The Centre for Outcomes Research and Effectiveness (CORE)
  • Depression Alliance
  • The Mental Health Providers Forum
  • Mind
  • The New Savoy Partnership
  • No Panic
  • Rethink
  • The Royal College of General Practitioners
  • The Royal College of Nursing
  • The United Kingdom Council for Psychotherapy

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